To Dose or not to Dose

Buddy & Sue

Buddy & Sue

Member
So Buddy & I are only 2 weeks into this journey. My Vet told me to give him is insulin if is BG is over 6. Based on the recommendations in the group I should not give it to him if under 10/11. I just tested him for his PM PS. It's 8.6 Based on what we have been doing I would give him his shot. If I don't because it is under 10 what might happen overnight? If it's high that's OK, but might it get too low because I didn't give it? Am I thinking of this backwards? Do I not need to worry about it going too low because he didn't get his insulin? Will not giving insulin when it is needed make him go low? Here is his spreadsheet for reference.

https://docs.google.com/spreadsheets/d/1N4l3sXT5Tgt6lYUaUT9GGlzjBsKNXZKQ7mOwxR93CLg/edit?usp=sharing
 
Buddy Smith said:
So Buddy & I are only 2 weeks into this journey. My Vet told me to give him is insulin if is BG is over 6. Based on the recommendations in the group I should not give it to him if under 10/11. I just tested him for his PM PS. It's 8.6 Based on what we have been doing I would give him his shot. If I don't because it is under 10 what might happen overnight? If it's high that's OK, but might it get too low because I didn't give it? Am I thinking of this backwards? Do I not need to worry about it going too low because he didn't get his insulin? Will not giving insulin when it is needed make him go low? Here is his spreadsheet for reference.

https://docs.google.com/spreadsheets/d/1N4l3sXT5Tgt6lYUaUT9GGlzjBsKNXZKQ7mOwxR93CLg/edit?usp=sharing
Click to expand...
When you get a lower preshot like that what you can do is stall without feeding for up to an hour and see if the number is going up.
 
Buddy Smith said:
If it's high that's OK, but might it get too low because I didn't give it?
Click to expand...
No. The BG will not get too low because you did not give your cat insulin.

The BG drops mainly in response to insulin. Since Prozinc is an in-and-out type insulin, the effects rarely last beyond 12 hours. In a few cases, the insulin can last longer in a particular cat, up to 13-14 hours in some cases, but that is unsual.
Buddy Smith said:
Will not giving insulin when it is needed make him go low?
Click to expand...
No.

Insulin lowers BG levels. Food raises them. Compensatory reactions in a cat's body can cause the BG levels to fluctuate in response to a low number. We call that a bounce.

Not giving insulin when it is needed will lead to the BG levels going higher.

6 times 18 = 108 mg/dL
8.6 times 18 = 155 mg/dL
 
Buddy & Sue said:
I still can't get my head around my vet saying don't shoot if under 6 but here it is don't shoot if under 11. That's a huge difference. He hasn't been over 11 at the PM PS since Jan 24th. I was afraid not to give it to him. His AM PS have been higher. It's all so confusing. :(
Here is his SS if anyone wants to take a look.
https://docs.google.com/spreadsheets/d/1N4l3sXT5Tgt6lYUaUT9GGlzjBsKNXZKQ7mOwxR93CLg/edit?usp=sharing
Click to expand...

Is there a reason you haven't reduced his dose to 0.75U? You've seen several nadirs below 5 mmol now, which warrant an immediate 0.25U decrease (have you seen the ProZinc dosing sticky here?).

The recommendation here is to not shoot below 11mmol until you have enough data/know how your cat reacts. Keep in mind the preshot values are less important than how low he is going during a cycle.

Look at your past few days of data - keep in mind 3.3 mmol is the hypoglycemia threshold. By following your vet's guidance, you are bringing him very close to (and a few times within) the hypo range.

I generally try not to make PZI dose recommendations because we weren't on it for very long, but I think you need to reduce to 0.75U right awau. And consider doing reduced or token doses when preshots are below 11 mmol.
 
FrostD said:
Is there a reason you haven't reduced his dose to 0.75U? You've seen several nadirs below 5 mmol now, which warrant an immediate 0.25U decrease (have you seen the ProZinc dosing sticky here?).

The recommendation here is to not shoot below 11mmol until you have enough data/know how your cat reacts. Keep in mind the preshot values are less important than how low he is going during a cycle.

Look at your past few days of data - keep in mind 3.3 mmol is the hypoglycemia threshold. By following your vet's guidance, you are bringing him very close to (and a few times within) the hypo range.

I generally try not to make PZI dose recommendations because we weren't on it for very long, but I think you need to reduce to 0.75U right awau. And consider doing reduced or token doses when preshots are below 11 mmol.
Click to expand...
This is why I am so confused. I have been told no shot below 11 and you are suggesting reduced doses. His PM PS was 6.2 Do I NOT give him a shot or do I reduced the shot?
 
Buddy & Sue said:
This is why I am so confused. I have been told no shot below 11 and you are suggesting reduced doses. His PM PS was 6.2 Do I NOT give him a shot or do I reduced the shot?
Click to expand...

As I mentioned, the 11 mmol is the recommendation for when you don't yet have enough data. You are starting to get enough data on how Buddy reacts that you can start adjusting to fine-tune things.

Per the ProZinc dosing sticky I linked earlier:

Until you collect enough data to know how your cat will react, we suggest following the guidelines in the FDMB's FAQ Q4.4:
Q4.4. My cat's pre-shot level was way below the usual value. Should I give the injection?
A4.4. There's no hard and fast rule, but if you don't have data on how your cat responds to insulin, here are some general guidelines.
  • Below 150 mg/dl (8.3 mmol/L), don't give insulin.
  • Between 150 and 200 (8.3-11.1 mmol/L), you have three options:
    • a.) give nothing
    • b.) give a token dose (10-25% of the usual dose)
    • c.) feed as usual, test in a couple of hours, and make a decision based on that value
  • Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise.
  • In all cases, if you are reducing or eliminating insulin, it's wise to check for ketones in the urine.


At this point I would go without the shot, it's late and I can't stay up to keep an eye out. But be sure to test for ketones.

But going forward, I would suggest a token dose when you get preshots in the 6-11 mmol range, if you can monitor him throughout the cycle. A few token doses will help you determine if it's better to skip a dose, do a token dose, or a reduced dose when you see lower preshots. It's all a game of trial and error, no hard and fast rule will work for every situation unfortunately.

I also suggest getting some more tests at night. We know he's going low during the day, he's very likely going lower at night (after the +3 tests you're doing) and you don't want to miss a hypo.

And again, I'd do 0.75U in the morning and hold that dose for a few cycles. I went through your post history, several people have recommended that now going as far back as Friday.
 
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*hold the 0.75U dose unless you see a number below 5 mmol, if that happens again it's another 0.25U reduction
 
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